His acute Liver Failure (ALF) was triggered by viral Hepatitis A
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A 30-year-old IT professional, Anish (name changed on request), was diagnosed with Hepatitis A infection. It was present in the most severe form and he also had acute liver failure as well as renal failure which was triggered by the acute liver disease.
Anish was admitted to Jehangir Hospital in Pune in the last week of June 2019. On admission, he had fever, was deeply jaundiced, was weak with an inability to eat and irrelevant speech at times. He was on an anti-epileptic drug to prevent fits which could sometimes lead to liver injury. He had sober habits and no pre-existing liver disease. On evaluation, he was diagnosed as Acute Hepatitis A - which is a type of food born hepatitis which generally occurs in children. Patients who get infected at a later age (after 25 yrs age) can have severe liver disease.
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His acute Liver Failure (ALF) was triggered by viral Hepatitis A. With no available liver treatment, such patients can only hope the liver improves with time or a liver transplant is the only other option. The potentially life-threatening condition starts with a seemingly innocuous viral hepatitis but progresses rapidly. In such cases, patients develop hepatic coma, kidney failure, Coagulation abnormalities often leading to death. Acute liver failure (ALF) is a condition where sudden extensive damage occurs in the liver due to various reasons. Some of the causes are treatable and the liver damage can be reversed but in most cases, a liver transplant may be needed.
In this case, the patient was discharged after almost 8 weeks of hospitalization without any need for a transplant. Gastroenterologist Dr Parimal Lawate, at Jehangir Hospital, who diagnosed the case said, "In this case, we could, however, salvage this patient using a new modality of treatment called CRRT which is now available St Jehangir Hospital. This helps in removing Ammonia and various toxins from the blood and helps rapid recovery from coma and renal failure. Using this technology, our patient completely recovered without the need for a Liver Transplant."
CRRT is an acronym for Continuous Renal Replacement Therapy. While the modality has been available for the past few years, it was introduced in Jehangir Hospital in March 2019. Dr Lawate explained, "In the field of gastroenterology, it is commonly used to remove toxins such as ammonia in patients with acute liver failure (which is an acute shutdown of liver function leading to inadequate clearance of ammonia resulting in a high ammonia level). This affects the brain and causes abnormal behaviour and coma. CRRT is especially helpful in the above condition where it selectively removes toxins such as ammonia. The patient's blood pressure generally remains stable unlike in regular dialysis - hemodialysis, where the patient's blood pressure can suddenly drop during the dialysis procedure when it is done in sick Intensive Care Unit Patients."
Nephrologist Dr Sunil Jawale who worked on this case with Dr Lawate says, "CRRT is used for patients with combined liver and acute renal failure because they are often hemodynamically unstable, which is why it was used in this patient's case as given by Dr Lawate." While the treatment is not cheap -- costing Rs 80,000-Rs 1,00,000 in consumables, CRRT is better than intermittent haemodialysis in patients who are hemodynamically compromised and gives better clearances. "In addition to Hepatitis A, Anish was on Carbamazepine as an anti-epileptic. He has received paracetamol as a part of his treatment for what initially appeared to be an ordinary viral fever. He had to be kept in the hospital for eight weeks to feed him via the tube as the recovery is slow. He will need followup for the next three months and once recovered will lead a normal life."
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